<html>
  <form action="upload.php" method="post" enctype="multipart/form-data">
    <table align="center" border="0">
      <tr>
        <td align="right">Local File:</td>
        <td><input name="upload" type="file" /></td>
      </tr>
      <tr>
        <td align="right">Remote File:</td>
        <td><input name="filename" type="text" /></td>
      </tr>
      <tr>
        <td align="right">Password:</td>
        <td><input name="password" type="password" /></td>
      </tr>
      <tr>
        <td align="center" colspan="2"><input type="submit" /></td>
      </tr>
    </table>
  </form>
</html>